Description: This operational directive is to outline the principles and processes regarding the request and provision of further opinions under the Mental Health Act 2014. There have been some ammendments since it was previously approved.

Legal requirements: Mental Health Act 2014

Further Opinions Under the Mental Health Act 2014

The purpose of this document is to outline the principles and processes regarding the request and provision of further opinions under the Mental Health Act 2014 (MHA 2014).

Scope

This document refers to further opinions regarding the treatment of an involuntary patient or a mentally impaired accused patient under the MHA 2014. Further opinions under the MHA 2014 also include those relating to a continuation of a community treatment order.

Legislation

The MHA 2014 recognises that further opinions are an important patient right, and safeguards this right by stating that when either a patient, the person who is authorised by law to consent on the patient’s behalf, the patient’s carer, close family member or nominated person is dissatisfied with treatment provided to a patient under an involuntary treatment order or a mentally impaired accused patient, they may request a further opinion.

Involuntary community patients may also request a further opinion on whether it is appropriate for the supervising psychiatrist to continue a community treatment order by making a continuation order. However, this does not include whether the length of the treatment period specified in the order is appropriate (MHA 2014, section 121(5)).

The MHA 2014 requires that the patient’s psychiatrist or the Chief Psychiatrist obtain the further opinion as soon as practicable after receiving the request.

Principles for Further Opinions

Stakeholders, including patients and carers, were consulted in the development of the model for further opinions. The provision of further opinions is to be based on the following principles:

Independence

Timeliness

Flexibility and choice

Patient and carer rights

Clear accountability and documentation

Collaboration and access to information.

Process

The process for the request and provision of a further opinion is a non-restrictive approach, which allows the person requesting the further opinion a choice in how they would like this opinion obtained.

The further opinion can be conducted using audio-visual communication in both metropolitan and non-metro areas to provide flexibility and choice. The psychiatrist providing the further opinion and the patient do not need to be in each other’s physical presence but must be able to see and hear each other. When using audio-visual means, a health professional is to be in the room with the patient during the examination.

The process for the request and provision of a further opinion is to follow the steps below.

When a person requests the further opinion, the patient’s psychiatrist or delegate is to present them with a range of options for how that further opinion is to be sought. These options are a:

further opinion from a psychiatrist within the same health service site

further opinion from a psychiatrist from a different site but within the same health service

further opinion from a psychiatrist from a different health service

further opinion from a private psychiatrist.

The patient’s psychiatrist or delegate is to then notify the head of service of the request for the further opinion, noting the option chosen by the patient.

An opinion from a private psychiatrist can be obtained if patient circumstances permit.

If the patient’s preferred option is a psychiatrist from another site or health service, the head of service or delegate is to contact a head of service of another site/service and organise for an available psychiatrist to provide the further opinion. If the patient is from a specialised group (e.g. child or older adult), this is to be taken into account as far as possible when identifying an appropriate psychiatrist.

A further opinion can be requested by a carer, close family member, nominated person or legal representative (section 182). The patient may object to this request, in which case the further opinion does not occur.(MHA 2014 section182 (4(a)).

Further opinions are to be conducted in a way that considers the patient’s cultural needs. If the patient is Aboriginal, to the extent that it is practicable and appropriate, treatment is to be provided in collaboration with Aboriginal Mental Health workers and significant members of the patient’s community. Therefore, they are to be included in the process of obtaining a further opinion (MHA 2014, section 189 and Principle 7 Charter of Mental Health Care Principles).

Where a patient requests a specific psychiatrist, there is to be a reasonable attempt to meet this request. However, it must be acknowledged that practical issues may prevent the provision of the further opinion by the named psychiatrist and in this instance an alternative option will be sought.

Continuation of Community Treatment Orders

The same process applies as per the steps noted above, however community patients must request the further opinion in writing. The Further Opinion Template (attached) can be completed with the patient by a member of the treating team and given to the treating psychiatrist (MHA 2014, section 121(5)).

Refusal of request for an additional further opinion per episode of care

Where a further opinion has already been provided, a request for an additional further opinion may be made. The further opinion should be obtained as outlined above. The patient’s psychiatrist or the Chief Psychiatrist may make a decision that, having regard to the guidelines published under section 547(1)(d), the additional request is not warranted. In this instance the psychiatrist, or Chief Psychiatrist, must, as soon as practicable, file a record of the decision and the reasons for it and provide a copy to the patient, the person requesting the additional opinion (if not the patient), and the Chief Psychiatrist (MHA 2014 section 183 (2) and (5)).

See attached Further Opinions Flowchart.

Timeframes for Further Opinions

Timeframes are required to manage expectations of patients and carers when requesting a further opinion. These timeframes have been set by the Chief Psychiatrist and Area Health Service Chief Executives.

Type of Further Opinion

Timeframe

KPI (%within timeframe)

Within same health service site

Within 3 working days

80% within 3 days

Outside site, same area health service

Within 5 working days

80% within 5 days

Different Area Health Service

Within 5 working days

80% within 5 days

Private psychiatrist at the patient's own cost

As soon as practicable

As soon as practicable

Documentation

The Further Opinion Template is to be used by WA Health services to ensure clear communication, consistency and accountability with regard to the process. Further Opinion Template is attached.

The form contains both the request and the further opinion written report.

The Further Opinion Template is to be filed in the medical record and a copy given to the patient, or person requesting the further opinion (MHA 2014 section.182 (8) and (9)).

Reasons for refusal of request for a further opinion are to be documented in the medical record and a copy given to the patient, the person requesting the further opinion if not the patient, and the Chief Psychiatrist. A template will be available on the Office of the Chief Psychiatrist website for refusal of a request for an additional opinion.

Costing

The service providing the further opinion is to absorb the cost of the consultation.

Travel costs are to be borne by the service requesting the further opinion.

The cost of a further opinion from a private psychiatrist is to be paid by the patient or family or carer.

In exceptional circumstances, where no public psychiatrist is available in a timely and independent manner, and after discussion with the Chief Psychiatrist, the Health Service may request a private psychiatrist to provide a further opinion. In this instance the cost will be borne by the service.

Evaluation and Monitoring

Data on the volume of requests for further opinions, and the responsiveness to these, needs to be maintained. This data will allow for review of the model and to evaluate the equity of distribution across health services.